TY  - JOUR
A1  - Sitter, Magdalena
A1  - Fröhlich, Corinna
A1  - Kranke, Peter
A1  - Markus, Christian
A1  - Wöckel, Achim
A1  - Rehn, Monika
A1  - Bartmann, Catharina
A1  - Frieauff, Eric
A1  - Meybohm, Patrick
A1  - Pecks, Ulrich
A1  - Röder, Daniel
T1  - ECMO-Therapie bei COVID-19-ARDS in der Schwangerschaft ermöglicht den Erhalt einer Schwangerschaft mit termingerechter Entbindung
T1  - ECMO therapy for COVID-19 ARDS (Acute Respiratory Distress Syndrome) during pregnancy enables preservation of pregnancy and full-term delivery
JF  - Die Anaesthesiologie
N2  - No abstract available.
KW  - ECMO-Therapie
KW  - COVID-19-ARDS
KW  - Schwangerschaft
KW  - ECMO therapy
KW  - COVID-19-ARDS
KW  - pregnancy
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-346762
VL  - 72
IS  - 3
ER  - 
TY  - JOUR
A1  - Zeiner, Carsten
A1  - Schröder, Malte
A1  - Metzner, Selina
A1  - Herrmann, Johannes
A1  - Notz, Quirin
A1  - Hottenrott, Sebastian
A1  - Röder, Daniel
A1  - Meybohm, Patrick
A1  - Lepper, Philipp M.
A1  - Lotz, Christopher
T1  - High-dose methylprednisolone pulse therapy during refractory COVID-19 acute respiratory distress syndrome: a retrospective observational study
JF  - BMC Pulmonary Medicine
N2  - Background
Current COVID-19 guidelines recommend the early use of systemic corticoids for COVID-19 acute respiratory distress syndrome (ARDS). It remains unknown if high-dose methylprednisolone pulse therapy (MPT) ameliorates refractory COVID-19 ARDS after many days of mechanical ventilation or rapid deterioration with or without extracorporeal membrane oxygenation (ECMO).

Methods
This is a retrospective observational study. Consecutive patients with COVID-19 ARDS treated with a parenteral high-dose methylprednisolone pulse therapy at the intensive care units (ICU) of two University Hospitals between January 1st 2021 and November 30st 2022 were included. Clinical data collection was at ICU admission, start of MPT, 3-, 10- and 14-days post MPT.

Results
Thirty-seven patients (mean age 55 ± 12 years) were included in the study. MPT started at a mean of 17 ± 12 days after mechanical ventilation. Nineteen patients (54%) received ECMO support when commencing MPT. Mean paO2/FiO2 significantly improved 3- (p = 0.034) and 10 days (p = 0.0313) post MPT. The same applied to the necessary FiO2 10 days after MPT (p = 0.0240). There were no serious infectious complications. Twenty-four patients (65%) survived to ICU discharge, including 13 out of 20 (65%) needing ECMO support.

Conclusions
Late administration of high-dose MPT in a critical subset of refractory COVID-19 ARDS patients improved respiratory function and was associated with a higher-than-expected survival of 65%. These data suggest that high-dose MPT may be a viable salvage therapy in refractory COVID-19 ARDS.
KW  - corticoid
KW  - methylprednisolone
KW  - pulse therapy
KW  - SARS-CoV2
KW  - ECMO
KW  - salvage therapy
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357231
VL  - 23
ER  - 
TY  - JOUR
A1  - Döhler, Ida
A1  - Röder, Daniel
A1  - Schlesinger, Tobias
A1  - Nassen, Christian Alexander
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
A1  - Lock, Johan Friso
T1  - Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery
JF  - BMC Anesthesiology
N2  - Background
Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events.

Methods
We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality.

Results
A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed.

Conclusion
It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low.
KW  - low-molecular heparin
KW  - atrial fibrillation
KW  - postoperative bleeding
KW  - thromboembolism
KW  - anticoagulation
KW  - bridging
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357305
VL  - 23
ER  -